Intact Perineum ~insight from a midwife

[doulala]

Intact Perineum
~insight from the dear Gloria Lemay~

An intact perineum is the goal of every birthing woman. Advising a
woman to do perineal massage in pregnancy implies a lack of confidence
that her tissues have been designed perfectly to give birth to her
infant. The intact perineum begins long before the day of the birth.
Sharing what the feeling of a baby's head stretching the tissues will
be like and warning the mother about the pitfalls in pushing will go a
long way to having a smooth passage for both baby and mother. The
woman will be receptive to conversations in prenatal visits about the
realities of the birth process. Here is the information I convey for
the second stage:

1. When you begin to feel like pushing it will be a bowel
movement-like feeling. We will not rush this part. You will tune into
your body and do the least bearing down possible. This will allow your
body to suffuse hormones to your perineum and make it very stretchy by
the time the baby's head is there.

2. The feeling will increase until it feels like you are splitting in
two and it's more than you can stand. This is normal, and no one has
ever split in two, so you won't be the first. Because you have been
educated that this is normal, you will relax and find this an
interesting and weird experience. You may have the thought, "(My
midwife) told me it would be like this, and she was so right. I guess
this has been going on since the beginning of humankind."

3. The next distinct feeling is a burning, pins-and-needles feeling at
the opening of the vagina. Many women describe this as a "ring of
fire." It is instinctive to slap your hand down on the now-bulging
vulva and try to control where the baby's head is starting to emerge.
This instinct should be followed. It seems to really help to have your
own hands there. Sometimes women like to have very hot cloths applied
to their perineum at this point. If you like or dislike the feeling,
say so.

4. Most women like pushing more than dilating. When you're pushing,
you feel like you're getting somewhere and that there really is a goal
for your efforts.

5. This is a time of great concentration and focus. Extraneous
conversation will not be allowed in the room. Once you begin feeling
the ring of fire, there is no need for hurry. You will be guided to
push as you feel like until the baby is crowning. All that will be
touching your tissues is the hot cloth and your own hands. It is
important for the practitioner to keep her hands off because the
blood-filled tissues can be easily bruised and weakened, which can
lead to tearing.

6. The point of full crowning is very intense and requires extreme
focus on the burning. It is a safe, healthy feeling but unlike
anything you have felt before.... Panting and rising above the pushing
urge will help you focus, and you will have less discomfort in the
long run.

7. You will be offered plain water throughout this phase because
hydration seems to be important when pushing. You can take the water
or leave it.

8. Once the head is fully born, you will feel a great sense of relief.
You will keep focused for the next sensation, which will bring the
baby's shoulders out and the baby's whole body will quickly emerge
after that with very little effort on your part. The baby will go up
onto your bare skin immediately, and it is the most ecstatic feeling
in the world. Your perineum may feel somewhat hot and tender in the
first hour after birth. The remedy that helps the most is to apply
very hot, wet cloths. This is in keeping with the Chinese medicine
theory that cold should never be applied to new mothers or babies.
Women report they feel instantly more comfortable when heat is
applied, and any swelling diminishes rapidly.

I also like to twist a diagonally folded bath towel into a very tight
roll and coil that into a ring for the woman to sit on when
breastfeeding.

-Gloria Lemay, "Midwife's Guide to an Intact Perineum," Midwifery
Today Issue 59

 

IN ADDITION:

Check out:
http://www.birthingnaturally.net/birthplan/hospital/episiotomy.html

I really think that episiotomies don't seem justifiable. (*In VERY rare circumstances, maaaaybe.) But many doctors do/did them routinely! Some Dr.s have 30% or higher rates. The more practiced mediolateral (angled) cut increases post-partum hemmorhaging 450% and 33% for the midline (straight down) cut. It only speeds up labor a contraction or two-- not worth the many complications that are involved, like incontinence and sexual displeasure. :-(

Please know that there are ways to avoid tearing, so birthing with the perineum intact (or mostly intact) is possible.

Consider: Perineal massage/oil, kegal exercises, water labor/birth, NO coached pushing, hand on the emerging head & perineum, blowing air Os slowly, intentionally slowing down the crowning through concentration. Be sure to stay upright, move & wriggle your baby down and out. :-)

The best way to prevent tearing - Honoring Body Wisdom

http://www.birthingnaturally.net/cn/technique/perineal.html

http://www.childbirth.org/articles/massage.html

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=31922

"The practice of perineal massage in labour does not increase the likelihood of an intact perineum or reduce the risk of pain, dyspareunia, or urinary and faecal problems."

 

 

 

Kegel exercises: How to strengthen your pelvic floor muscles

http://www.mayoclinic.com/health/kegel-exercises/WO00119

Kegel Exercises for Your Pelvic Muscles

How do pelvic muscles get weak?

Pelvic muscles help stop the flow of urine. For women, pregnancy, childbirth and being overweight can weaken the pelvic muscles. For men, prostate surgery can weaken pelvic muscles. Weak pelvic muscles can cause you to leak urine. Fortunately, pelvic muscles are just like other muscles--exercises can make them stronger. People who leak urine may have better control of these muscles by doing pelvic muscle exercises called Kegel exercises.

Which muscles control my bladder?

At the bottom of the pelvis, several layers of muscle stretch between your legs. The muscles attach to the front, back and sides of the pelvic bones. Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle (see picture below).

These are the same muscles that you would use to try to stop the flow of urine. They are the muscles you will exercise and strengthen.

How do I exercise my pelvic muscles?

You can exercise almost anywhere and any time--while driving in a car, at your desk or watching TV. To exercise these muscles, just pull in or "squeeze" your pelvic muscles (as if you are trying to stop urine flow). Hold this squeeze for about 10 seconds, then rest for 10 seconds. Do sets of 10 to 20 contractions per day.

Be patient and continue to exercise. It takes time to strengthen the pelvic muscles, just like it takes time to improve the muscles in your arms, legs or abdomen. You may not notice any change in bladder control until after 6 to 12 weeks of daily exercises. Still, most women notice an improvement after just a few weeks.

A few points to remember

• Weak pelvic muscles often lead to urine leakage.
• Daily exercises can strengthen pelvic muscles.
• These exercises often improve bladder control.
• Ask your doctor or nurse if you are squeezing the right muscles.
• Tighten your pelvic muscle before sneezing, lifting a heavy object or jumping. This can prevent pelvic muscle damage and urine leakage.

http://familydoctor.org/online/famdocen/home/women/reproductive/gynecologic/642.html

 

[Cecropia]

Jan. 27, 2008 at 12:53 AM I love these reminders of what birth feels like :-)

[Mammalia]

Jan. 27, 2008 at 3:01 AM Ditto. I just went down memory lane to my birth in the bathroom almost one year ago. Ahh...

[mommyofkaris]

Jan. 27, 2008 at 9:30 AM This is great information for me because I have no clue what it feels like... I had an epidural with my daughter and tore horribly.  The doctor had me push her out in about 10 minutes (I pushed when she told me to)!  I ended up having major scar tissue from the tearing, so I DO NOT want to tear again!  I will probably have to do some perineal massage because of the scar tissue, but I am confident that I can have an intact perinium this time! 

[OliversMommy411]

Jan. 27, 2008 at 9:59 AM This reminds me of how my son's birth went, exactly.  Calm, and full of knowledge!  I had two stiches in the end but couldn't even feel it.

[livewell]

Jan. 27, 2008 at 12:16 PM rubbing the perineum with a neutal oil and stretching it months before will make it easier...and can be fun ;-)

[Rendezvous2.2]

Jan. 27, 2008 at 12:49 PM i didn't know any of this information before. i didn't even know that it was possible to have some level of control on whether or not your perineum is in tact. thanks!

[Xakana]

Jan. 27, 2008 at 12:56 PM Why aren't any of these midwives around me? It's not fair, it really isn't. I was told to push before I was ready and I thought that meant I was ready and harassed when I tried to rest. Which, of course, led to me 'failing' because my choices were push until I was purple or have a cesarean. Finally, when I was so exhausted I couldn't move anymore, I gave up to the second option. All I wanted was to be allowed to push as I felt was necessary, for as long as felt comfortable. Instead, I was told how horrible I was doing at it and berated for not even trying, because I wouldn't grab my thighs (I wanted my hands above my head, desperately and I was yelled at every time I put them there--I think I wanted to be holding a rope or something and squatting, but that wasn't available to me).

[doulala]

Jan. 27, 2008 at 1:32 PM Xakana~ I am sorry you had that experience. Too many women learn how they want to give birth by contrasting their previous birth(s). We put trust in our caregivers, hoping & expecting they will give us all the best, but really it's up to each woman to take full responsibility and demand it be HER way. That's not easy and not persued too often. Knowing how to conduct your ideal birth AND be cognizant it it's midst to stay on track is really an effort. You are on the path & you'll enjoy the next one, I am certain!!

(Original Poster)

[auspicious]

Jan. 27, 2008 at 8:34 PM Thank you for posting this!

[aridattebayo]

Jan. 28, 2008 at 9:32 AM I wish I would have known this. I have 3rd degree lacerations from my birth last year...   thankfully I didn't feel myself rip due to a pudental block (I didn't have an epidural)... I also couldn't stop the pushing once my water broke so I went with it (I think it helped Arianna decend because as soon as I was fully dilated her head was practically crowning and I did maybe 3 pushes and she was out.) Stupid forceps probably ripped me. :(